Viral retinopathies: a spectrum of disease from East to West

Viral retinopathies remain an absolute emergency among all other infectious entities. They may occur in immunocompromised or immunocompetent patients at any age. Most of the cases are associated with herpes viruses and happen to be necrotizing. Acute retinal necrosis has been initially described in Japan with important clinical characteristics. Molecular tools are of utmost importance in order to confirm the viral type. VZV seems more aggressive than HSV1 or 2. CMV retinitis occurs more frequently in immunocompromised patients. More recently, the nonnecrotizing type of viral retinopathy has been reported, masquerading as different autoimmune entities. Furthermore, other types of nonherpetic viral retinitis may be encountered in different geographical areas. Treatment is always challenging. Despite a few reports on the use of oral antivirals, most of the patients require intravenous therapy and intravitreal injections. Treatment is always long in order to prevent a relapse, especially in the second eye. Laser photocoagulation has not demonstrated its efficacy but may be proposed in selected cases. Primary vitrectomy should not be proposed in all patients as it may increase the risk of retinal detachment. Visual prognosis is guarded.